High Risk Crack Use Settings and HIV in El Salvador

描述(由申请人提供)：拟议的项目是“萨尔瓦多的高风险吸毒环境和艾滋病毒”的延续，并建立在艾滋病干预研究中心(CAIR)、美国中央大学(UCA)和萨尔瓦多反犯罪基金会(FUNDASALVA)之间的成功研究合作的基础上，以测试在母项目中与社区居民、吸毒人员以及公共卫生和社会服务部合作开发的多层次社区干预措施。Encuentro项目包括在吸毒者中提供社交网络、艾滋病毒检测和同伴网络干预。拟议研究的具体目标是：(1)衡量多层次社区干预措施在提高吸毒者的检测率和减少性危险行为方面的有效性；(2)分析同伴网络和社会网络艾滋病毒检测组成部分对提高吸毒者的检测率和减少吸毒者的性风险行为的综合影响；(3)探索成功实施或不成功实施(系统水平分析)多层次社区艾滋病毒预防干预措施的各个组成部分的社区和组织因素。为了实现这些目标，我们将使用定性和定量相结合的方法。为了探讨目标1和目标2，我们将对在4个社区网站居住、购买或使用裂缝的吸毒者进行横断面调查(每次评估300人)，并在实施社会网络艾滋病毒检测之前和之后测量MSPA诊所的艾滋病毒检测率。干预部分的实施将连续展开，我们将进行多项评估(共6项，包括2条基线)，以评估干预部分的效果随着时间的推移不断增加的趋势。我们还将仔细衡量接触非Encuentro艾滋病毒预防干预措施和信息的情况，以进一步排除与我们的干预措施无关的历史性变化。为了探索目标3，我们将与社区合作伙伴进行半结构化访谈，并观察培训、社区会议和指导委员会会议。为了检查干预组件的保真度和质量，我们还将收集艾滋病毒检测的观察结果，以及与吸毒者进行的对等网络干预会议。具体目标3的数据将在整个项目中收集。将对主要信息提供人的访谈和观察结果进行编码，以反映与在四个社区地点成功实施干预措施有关的关键系统因素。编码障碍和促进者随后将作为数据纳入每个社区的横断面调查，对应于实施干预措施和实地观察或访谈的相同时间段。

DESCRIPTION (provided by applicant): The proposed project is a renewal of "High Risk Crack Use Settings and HIV in El Salvador" and builds on a successful research collaboration between the Center for AIDS Intervention Research (CAIR), the Universidad Centroamericana Jos¿ Sime¿n Ca¿as (UCA) and the Fundaci¿n Antidrogas de El Salvador (FUNDASALVA) to test a multi-level community-based intervention developed in the parent project in collaboration with community residents, crack users, and the Ministry of Public Health and Social Services. Project Encuentro consists of provision of social network HIV testing and Peer Network Interventions among crack users. Specific aims of the proposed research are: (1) To measure the effectiveness of the multi-level community-based intervention with regard to increasing testing rates and decreasing sexual risk behavior among crack users; (2) To analyze the combined effects of the Peer Network and social network HIV testing components on increases in testing and reductions in sexual risk behavior among crack users; (3)To explore the community and organizational factors of successful or unsuccessful implementation (systems level analysis) of various components of the multi-level, community-based HIV prevention intervention. To accomplish these aims we will use a mixed qualitative, quantitative approach. In order to explore aims 1 and 2, we will conduct cross-sectional surveys with crack users residing, buying or using crack in each of the 4 community sites (n=300 per assessment) and measure HIV testing rates in MSPAS clinics before and after implementation of the social network HIV testing. Implementation of the intervention components will be rolled out consecutively, and we will administer multiple assessments (6 total, including 2 baselines) in order to assess trends in increasing effects of the intervention components over time. We will also carefully measure exposure to non-Encuentro HIV prevention interventions and information, to further rule out historical change unrelated to our intervention. To explore aim 3, we will conduct semi-structured interviews with community partners, and observations of trainings, community meetings and steering committee meetings. To examine fidelity and quality of intervention components, we also will collect observations of HIV testing, and sessions of the Peer Network Intervention with crack users. Data for Specific Aim 3 will be collected throughout the project. Results from key informant interviews and observations will be coded to reflect key systems factors related to successful implementation of intervention components in the four community sites. Coded barriers and facilitators will then be included as data in the cross-section surveys for each community, corresponding to the same time periods of intervention implementations and field observation or interviews.